ACL Injuries: Career Threathening or Not?

July 26, 2018

Michael Owen, Zlatan Ibrahimovic, Francesco Totti and Paul Gascoigne
have all suffered anterior crucial ligament (ACL) rupture during their careers.
While these injuries are relatively rare in professional football, when
compared to muscular strains and ligament sprains, they can be extremely
severe. While all of these players returned to the pitch, an unlucky few will
not be so fortunate. Stuart Holden is one of the unlucky statistics.

Stuart had a succession of issues to his knees, initially he
injured his left knee in a tackle in 2011. He suffered a deep laceration to the
outside of his knee from Johnny Evan’s studs. This required 26 stiches, and was
not the worst consequence of the clash. A fracture of his femur ruled him out
for 6 month. Stuart made a successful return from this injury, but in a routine
follow up procedure, cartilage damage was noted and he was again out for a
further 6 months. Again Stuart returned to the pitch, although this time it
took 16 months of rehab and training. After a year and a half of regular
football and a call up the US national team, Holden tore his opposite knee’s
ACL in the final of the CONCACAF Gold Cup.

By this stage Stuart’s knees were his weakest link. One knee
injury had interrupted his training schedule and lead to 16 months of surgeries
and recurrent rehabilitation. This would have led to combination of his right
leg compensating for this left knee injuries, and small muscular imbalances.
These small imbalances in his leg strength, power and agility would have
developed due to the disruption to his high performance training over the
previous 16 months layoff. This would have contributed to the development of
his right leg ACL tear.

After 9 months of rehabilitation, Stuart returned to the
pitch again. Unfortunately his return last 23 minutes. He re-ruptured his right
ACL, and only played a handful of games after this rehabilitation. The
succession of injuries to Stuart’s knee punctuated the last few years of his
career and ultimately lead to his retirement at the age of 28.

Stuart was one of the unfortunate few who’s knee injuries,
and specifically his ACL tear, ended his career early. His story highlights how
serious an ACL tear can be. Even though stories like these are relatively rare
at the professional level, the stats show that most team will suffer at least
one ACL rupture to one of their squad players each year. This will rule someone
out for 6-9 months, and may affect their performance on their return.

Many players have lost that extra yard of pace after
extended rehab periods – meaning that if they do return it maybe as a shadow of
their former selves. Take the first two player mentioned in the article. Zlatan
injured himself in his mid 30’s - usually a players twilight years. You would
expect a player of his age to see his stats slowly deteriorate. However, prior
to his injury he played 46 games and averaged over a goal every two games. A
great return for a player in his mid 30’s. In his second season, post ACL
rupture, he played 7 games scoring once. His ACL injury resulted in a dramatic
loss of game time, and his goal return was the worst of his career. His ACL
injury hasn’t stopped him playing, but it undoubtedly affected his
effectiveness at the highest level.

If we look at Michael Owen, we see a similar story appear.
Michael was always susceptible to injuries, and his early years as a football
prodigy were interrupted with minor muscular strains. He was, however, relatively
consistent over all these seasons for goals scored and games played – meaning
that these injuries didn’t have a detrimental effect on his footballing
abilities. In 2007, with the England squad, he ruptured his ACL – perhaps all
those previous injuries created muscular imbalance in his legs leaning him
vulnerable to a rupture. By 2008, he had returned from a successful
reconstruction procedure but he wouldn’t play for England again after that
year. By 2009, Michael was now a squad player at club level. Unfortunately he
would never reached double figures for goals scored in a season again. This was
a dramatic turnaround for a player who 10 years earlier was challenging Zidane
for the World Player of the Year award at only 19 years old.

While Michael and Zlatan’s careers weren’t ended by ACL
rupture, their phenomenal talent was dramatically affected. These stories that
display the severe effects of ACL rupture lead us to a number of questions. What
causes ACL tears? How can they be prevented? How are they surgically repaired?
And when they do happen, what can be done to minimise their long term
consequences and allow the player to return to peak performance? In this injury
series will we present a weekly blog on each of these topics, coupled with
videos to show you what goes on in one of sport’s most severe injuries.